Wednesday, August 16, 2017

Your Health Care Is Costing You Too Much!


Yep, we Americans are all paying too much for health care. According to Eric Topol in The Patient Will See You Now, the future of medicine is in your hands,  Some hospitals charge up to $1,200 for every $100 of their total costs. And the 100 most expensive hospitals charge 7.7 times their cost. For example, a single tablet of acetaminophen will at $1.50 to your bill, while you can buy a whole bottle of 100 pills will cost you $1.49.

The U.S. is the only country that doesn't control the cost of health care. In Spain a hip replacement is $7,731, while in the U.S. the average price is $40,364! Are you aware that the average uncomplicated pregnancy in the U.S cost $37,341! This is why medical tourism is so popular. People go out of the country to receive reasonable health care.

What other market would consumers have no idea what they are being charged or how much the insurance will pay until after the service? Why are we unable to shop for medical care the same way we shop for an automobile?

Hospitals, doctors, and labs bill uninsured individuals and insureres vastly different amounts for the same service. The charges are not based on costs but on whatever the market will bear. Almost all other developed countries' governments negotiate and regulate pricing. The powerful lobbying groups of all sectors of health care make sure that doesn't happen here. And we, like sheep, allow it to continue.

Research has identified six areas of waste that could bring down the cost of health care. They was five years ago. Little has been changed since. These areas of care are, Inefficiently delivered services, prices that are inflated, excess administrative costs, fraud, missed prevention opportunities, and Unnecessary services - the biggest wedge of the waste pie.

There are many widely used medications that have no research showing their efficacy. Many are widely advertised as better than older medications, even though there is no evidence to support that. Patients expect the newest drug, whether it is better or not. And because it is thought to be better, companies can get away with overcharging for it."More than 1 in 10 Americans takes an antidepressant and for women age forty to sixty, the rates is 1 in4. But studies have shown that more than 2 out of 3 of the patients taking those drugs do not fit the accepted criteria."*

And then there is the failure to use pharmacogenomics to determine what medication best fits the individual needing it. Pharmacogenomics is the use of your genetic markers to trace which meds work for which person. This is an exciting new field of research that is being practically ignored. Only a very few medications have been researched for the genomic or biomarker for predicting responsiveness to common conditions. Using this information could lead to a major turnaround in effective medical care. A recent look at cancer patients has shown this to be a very hopeful field of science. And it could make enormous changes if more common conditions were studies.

And then, of course, is the unchecked use of medical imaging - CT scans, MRI, ultrasounds, mammography. The use of scans in the U.S. dwarfs their use in an;y other country in the world. MRI and CT scans in the U.S. exceed $250 billion. On top of the financial costs, 3 to 5 percent of folks getting scans will get cancer because of the cumulative exposure to ionized radiation. How many of these scans are necessary?

Women have routinely been getting mammograms annually in the U.S. Yet most of these women are not high risk for cancer and are exposing themselves unnecessarily to increasingly high amounts of accumulated ionized radiation. And recent research has shown that frequent mammograms have not been shown to result in a lower rate of breast cancer. Other countries have even eliminated mammograms without evidence of an unexplained lump or other symptom. Yet, as long as our insurance pays for the scan, Americans do it "just in case." We are never told about the amount of radiation we are exposed to and how much we have accumulated over the years, even though there is research to support the fact that radiation causes cancers.

Many of these imaging centers cost millions to build and operate, so the cost to the consumer is high, especially when those costs are inflated when passed on. 

How many of us get annual physicals, even when we have no symptoms or history that would support the need for a physical? Other countries have recommended giving up annual physicals. The annual physical has become an American ritual, with more tests, more scans, more procedures and more operations. Is it any wonder that there is such a battle around health care? Someone is making a lot of money on our perceived need for all this. And most of us are unwilling to let go of that belief, especially our medical professionals who reinforce it. Doctors are still paternalistic gods who know what is best for our bodies, even when we know more about or own bodies than they.

This has been the history of health care in America for centuries. We own our bodies but not information about our bodies. We are convinced that we couldn't possibly understand the complexities of our own health. The future will change all that. In my next blog we'll look at the impact of the information age on our ownership of our healthcare.

*This blog is based on the book The Patient Will See You Now, the future of medicine is in your hands, by Eric Topol.

Sunday, August 13, 2017

The Future Medical Practice Is Here


Your smartphone is your door to your medical care.* We now have technology that will make going to the doctor less frequent and less expensive and far more convenient. Are you aware that in undeveloped countries doctors are few and far between? And medical tests are often out of the question because of lack of access. Yet technology is changing that.

For years technology has made it possible for doctors to see patients via teleconferencing/Skype. It's been used in the U.S. prisons when it isn't practical to take the prisoners to doctors or hospitals.They can now connect with clinics or nurses via the Smartphone anywhere there is wifi.

But technology has taken it way beyond that. They have developed apps that will test blood sugar and other blood tests, pulse, blood pressure, temperature, etc. And the results can be analyzed almost instantly with results to you and your doctor.

There are even apps that will test your genome type and screen for potential genetic disease. And recently I saw an article that explained an app that can change the genetic structure of a cell in order to cure certain cancers!

There are also algorithms that diagnose illnesses with greater accuracy than humans given the same data about the patient. "With demographic, physiologic, anatomic, biologic and environmental data about a particular individual can be used to define one's medical essence."*

And with the proliferation of wearable wireless sensors, like FitBit and others, physiologic data is collected and relayed like a smartphone. By way of electronic monitors Individuals can transmit information from their body to medical professionals [or medical data centers] to monitor heart rate, pacemaker activity, blood oxygen levels, weight changes, blood pressure, respiratory rate, galvanic skin response, eye pressure, blood glucose, brain waves, intracranial pressure, muscle movements, and many other metrics.

"The microphone of the smartphone can be used to quantify components of lung function and analyze one's voice to gauge mood or make the dignosis or Parkinson's disease or schizophrenia. One's breath can be digitized to measure a large number of compounds, such as nitric oxide or organic chemicals, which could enable smartphones to track lung function or diagnose certain cancers.  Beyond all those wearable and non invasive sensors, nanochips are being developed to be embedded in the bloodstream to monitor the appearance of tumor DNA, immune activation, or genomic signals indicative of a forthcoming heart attack or stroke."  It is used to track the progress of chemotherapy in shrinking/eliminating cancerous growths.

We've all seen technological advances in scans of the anatomy of individuals beyond Xray - MRI, CT, nuclear scanning, and ultrasound - that define one's anatomy without surgery. All these scans however rely on access to expensive hospital and clinic-based equipment. There is now an emerging use of pocket devices that obtain high-resolution ultrasounds or X-rays making assessment of individual's anatomy much easier, faster, and cheaper. A smartphone or some other small device can now perform the physical exam of the eyes, ears, neck vessels, heart, lungs, abdomen and fetus, and share share medical imaging that enables the patient to fully review his/her anatomy on a portable device. All this is already available.

So why are you still waiting weeks or months to see a specialist, waiting hours for your turn to see the doctor, paying outrageous amounts of money, to get vague explanations of what is happening in your body?  That's an easy one to answer.

While the technology is changing at breakneck speed, the medical profession is not. They are highly invested in the status quo. Why would they support advances that minimize their control over diagnosis and treatment? Why would they support development of technology that makes them less relevant? For them to change would mean a whole culture change in the field of medicine. While some places in the world are using these technologies where medical care is inaccessible, we in developed countries are being left behind. Hard to imagine that our medical care is less advanced than that of the more undeveloped parts of the world.

But change will not be held in check for long. As we become more aware of what is happening around the world we, as consumers, will demand better care. One reason the change will reach us is that it will be less expensive. Insurance will push for lower costs, as will we all.

We must take ownership of our medical information, as we have every right to our records and to information about diseases. We are smarter consumers now that we have access to the internet's vast body of information on illness and disease. And we have the power as a group to demand easier access and lower prices.

Together we can make lives better with better medical access in all countries in the world. With wifi access spreading everywhere, so then can medical care. The change is happening. Be part of it!
, by Eric Topol.

*The Patient Will See You Now, the future of medicine is in your hands, by Eric Topol

Wednesday, August 9, 2017

Yes, Change Is Happening And You Are Part of It



The medical profession has changed slowly for centuries, and then a very rapid change has nearly left us in the dust. Scientists are finding causes and cures for illnesses that in the past were always fatal, even with treatment. Vaccines and medicines are making some illnesses obsolete.

For hundreds of years illness was thought to be caused by divine, or evil, spirits. The first "doctors" were priests or shamans, who could intercede for the person suffering with an illness. The most important figure in ancient Egyptian medicine was Imhotep, way back in 2600 BC, a high priest.  It wasn't until Hippocrates, considered the father of medicine, in ancient Greece that anyone described many diseases as due to natural circumstances rather than a supernatural force. ( The Patient Will See You Now, The future of Medicine is in Your Hands, by Eric Topol)

Hippocrates is considered the father of medicine and his philosophy shapes the medical culture to this day as paternalistic and somewhat secretive. He believed that the patient should not be told what treatment entailed and the science of medicine should be held as above the understanding of the common man. The Hippocratic Oath states that "the precepts and oral instruction and all the other learning of medicine be shared only with those who have taken an oath according to the medical law, but to no one else."

Eons later that same oath and philosophy has led to the culture of medicine that puts the patient in a subordinate role in his or her own healing. Doctors are still often treated like gods and, in turn, they treat patients like children by withholding information and making life and death decisions for the patient without the patient's input.

While the medical profession insists that they must be given respect, all to often the patient is not treated with respect. The patient does not have all the information available to them when they are told they must make decisions about possible treatments, making informed consent a misnomer. The patient is treated like a child when they ask for more information or when they are resistant to the doctor's treatment decisions.

An informed patient who insists on the doctor's respect is all to often labeled a "difficult patient" and shunted off to the side. When a patient is insistent the doctors label them difficult. That label in a patient's record can have longstanding consequences with any medical professional reading those notes.

Now, however, patients more and more often have access to information about illness and medicine that was never before available to the layperson. We can go online and find research results and reports about all sorts of illnesses. We can look up or symptoms and learn possibilities even before we see a doctor. We are more informed than ever before. And we are demanding medical professionals hear us and respect what we know about our own bodies.

And this is changing the culture of medicine. With the proliferation of smart phones we can have access to doctors, research, test results, and be part of the conversation about our health. As this trend grows medical professionals will be forced to change the way they treat patients. We will insist that be become Individual, Active Participants (IAPs) rather than patients. Because we know our bodies better than anyone else can, our input is vital. And with better information we can make better choices, we can have true informed consent.

Just think of that word "consent". What other profession demands its clients give consent to leave a relationship. But to leave a hospital without the doctor's consent is the same as being a defiant revolutionary! The doctor is assumed to have ownership over our lives when we agree to their treatment. When our decisions are made as a result of intimidation are they truly informed consent?

In the new medical culture the doctors will work for us as equal partners. Yes, the professional has more education and training in medicine. We don't dispute that. Yet they don't have the right to decide for us what we want to do about our health, unless we give up that right and go back to the paternalistic philosophy of Hippocrates.

The new generations of doctors will listen to and respect their patients as partners in their healthcare. I feel truly blessed to have a doctor like that now. My doctor knows that I am the expert on my body and what does or doesn't work for me. She listens and agrees to try what I think will work best. I get lab results with the values for each test given, not a rubber stamped "all tests were within the normal range" or a brief "good". When I have questions or concerns I am attended to.

But the changes in medicine are not stopping there. In the future of medicine our professionals will be more accessible than ever before, thanks to technology. More about that in my next post.

*The facts in this post come from the book The Patient Will See You Now by Eric Topol.




Sunday, August 6, 2017

Changes

Yes, the world  is changing. And the changes come more and more quickly. 

While is can be exciting it can also be stressful. Whether the changes are for our good or not, all change creates stress. So it is little wonder that so many of us are challenged by that stress.


Let's look at the positive sides of change as one way to minimize the negative effects of stress. In the next weeks I want to look at some of the changes and how we might better deal with them.


Get ready, because change will come no matter what we do.

Wednesday, August 2, 2017

We Can Do Better


With so much of our energies focused on profit, the United States has fallen short on comparisons with other countries in other areas.
"The USA may still lead the world in GDP and rank highly in such stats as population and human development index, but its lag in other key categories is alarming. You’ve heard about the education gap, but did you know that U.S. students’ math scores are among the lowest in the developed world? Charles M. Blow and the New York Times put together this infographic comparing the U.S. to other countries by 9 key metrics: The U.S. comes in at “worst of the worst” in four categories and “worst” in two more, with zero “best” rankings."
https://www.themarysue.com/us-compared-to-other-countries/
Life is about so much more than money. We can do better. We can work together to create a better quality of life for ALL people in America. We can return to being the hope of the world.

But it won't be easy and it won't be quick. We have to support initiatives that build people up. We need to get behind improving our educational system by teaching kids how to think, how to reason, how to make good decisions. This isn't something learned by rote memory. I'm not even sure there are tests that can measure that. But we have at least one generation, probably more than one, that lacks these life skills.

Math and science are important. And just as important are creative arts. When people have basic knowledge and their creativity is encouraged they can create solutions to all kinds of problems.

We need to push for wage equality and food security. Families can survive, let alone thrive, on minimum wage and monthly trips to a food pantry. We must see that children are educated and able to work, yes. AND we need to be sure there are jobs for them and their parents to move into.

You are probably thinking that you can't do anything about any of this. But that is where you are wrong. We are the people who hold the keys. We can vote into office progressive people who will support these initiatives in our cities, states, and nation.

We are also the people who can support organizations that push for these improvements. We do that with donations, volunteering, sharing information, and letting those organizations know that we think they are doing important work.

It is easy to feel small and helpless. But when we do, we give up or personal power. We really can't afford to do that.

So let's find an area we support and get busy!

Sunday, July 30, 2017

What Is a Right?


Do we still have rights? What is a right, anyway? It isn't a law. Laws are made by governments, supposedly to uphold and protect its citizen's rights.

"A right is a gift from God that extends from our humanity," according to Judge Andrew P. Napolitano. Rights are a natural part of our humanity. "Thinkers from St. Augustine to St. Thomas Aquinas, from St. Thomas More to Thomas Jefferson, from the Reverend Rd. Martin Luther Kng Jr. to Pope John Paul II to Justice Clarence Thomas"* all argued this to be true. These are the inalienable rights named in our U.S. Constitution.

And the founders of our nation believed that the role of government is to protect and preserve the rights of every individual. And the only way it gets the power to do that is through the consent of the individuals involved. At least that is the way it is supposed to be.

I'm not so sure that is the way things are now. Nor are the people at the top of our government in agreement with that philosophy of our founders. The government has become the micromanager of the people today. And, over time, the citizens have given them way more power than the founders ever wanted the government to have. We have defaulted to being taken care of rather than to be the caretakers of our own lives.

Think about it. The government determines what crops can be grown, what medications can be manufactured, the cost of many goods and services, where resources can be obtained, who can pollute the air, water, soil. There are government controls on so many things that a full list would take pages and pages.

So much of this control was in the name of protecting us. And to a point that is true. Yet the misuse of that power has created harmful situations and inflated prices. Somewhere along the line the country has gotten off track and is in a mess. Is it possible to clean it up? I don't know. Some days I believe it can. Other days I don't.

What do you think? If we all worked together we could make it happen. If we can bridge the divide we could work for a better world, starting in our own country.


*It Is Dangerous To Be Right When the Government is Wrong by Andrew P. Napolitano.

Wednesday, July 26, 2017

Is This Really a Free Country?


I picked up a challenging book at the library. It is slow going, but it is so thought provoking that I have to read on. The book is It Is Dangerous to Be Right when the Government Is Wrong, The case for personal freedom by Judge Andrew P. Napolitano.

The reason I am reading it is that it explores the government's role in keeping us free, something that is on our minds a lot these days of political turmoil in Washington. The book takes us back to basics on freedom, addressing some hard questions.
  • What is a Constitution, and do we still have one?
  • What are the limits to government power to in a free society?
  • Why does the government attack, rather than defend, our rights?If our rights are inalienable, how can the government take them away? 
  •  Do we really own any private property?
Interesting, to say the least.

Judge Napolitano is a  lecturer on the U.S. Constitution, the rule of law, civil liberties in wartime, and human freedom. And he writes about this complex subject with illustrations that help lay people like me better understand it.

I'm not very far into the book, but already I keep asking things like: "who owns my body?" "Who decides what laws we must obey and which we can challenge?" "How are rights different from laws?" "Are we really all created equal?"

I don't know how far into the book I'll get before I'm totally overwhelmed. But I'm giving it a try.

What are you reading this summer? I'd love to know.